Pancreatic Cancer Treatment London

Treatment of Pancreatic Cancer in London

For the majority of patients with pancreatic cancer, by the time they develop symptoms and the diagnosis is made, their disease is too advanced to be cured by surgery. If scans shows that the tumour is potentially operable, then the patient should be considered for surgical resection, as that offers a chance of a cure. Age, other illnesses and overall fitness have to be taken into account. For those patients who have inoperable disease, palliative treatments are offered.

The most common form of palliation is to relieve jaundice either by placement of a plastic or metal stent at endoscopy or a bypass operation. Further palliative therapy can include chemotherapy or a combination of chemotherapy and radiotherapy.
Chemotherapy given alone is useful for disease that has spread beyond the pancreas. Chemotherapy and radiotherapy together are generally reserved for locally advanced tumours that have not yet spread to reduce their size and allow removal at operation in the future. It is important to know that this therapy is only infrequently successful.

Find further information below on the different treatments for pancreatic cancer:

Surgical resection

The standard resection for a tumour of the pancreatic head, duodenum, bile duct or the ampulla is a Pancreatoduodenectomy.

Originally known as the Whipple operation (but now slightly modified), this involves removal of the pancreatic head, along with the duodenum and the lower part of the bile duct. Total pancreatectomy (removal of the entire gland) is warranted only in rare situations where one is dealing with multiple tumours
within the gland, or the body and tail of the gland are very inflamed or friable.

For tumours of the body and tail, distal pancreatectomy with splenectomy is the standard. This involves removal of the body and tail of the gland along with the spleen. When resecting the pancreatic tail for a benign lesion, the surgeon may attempt to preserve the spleen if possible.

The chance of a complication occurring after this operation is quite high (30-50%). This may be a small and relatively insignificant complication such as a minor wound infection. Alternatively it may be a significant problem that delays your discharge from hospital, requires more surgery and may even be a reason for not surviving surgery. Common problems after pancreatic surgery are wound infections, intra-abdominal infections, leaks from one of the many joins created during the operation, delayed stomach emptying with requirement for alternative feeding temporarily and long-term reduction in pancreatic enzymes to help digest food.

Steatorrhoea (diarrhea due to enzyme deficiency) is the presenting problem of malabsorption after pancreatic surgery. Therefore it is common to end up on creon capsules with your meals after pancreatic surgery to replace what you are missing. This is carried on for life. Diabetes is actually quite rare after pancreatic surgery for cancer. Diabetes mellitus, if it develops, is treated with tablets or insulin as appropriate.

Resectional surgery for pancreatic cancer should be carried out in specialist units. There is a clear correlation between higher caseload volume and lower hospital mortality and morbidity. The operation should carry a mortality rate of no more than 3-5%. The team from the London Bridge come from two designated pancreatic cancer centres nationally.

Together they care for all the pancreatic problems in populations in excess of five million. You are guaranteed to get experts in your condition if you come to the London Bridge. They are backed by a team of gastroenterologists expert in endoscopic ultrasound, ERCP, stenting, endoscopic removal of some small tumours, oncologists expert in radiotherapy and chemotherapy, a full palliative care team comprising palliative care nurses and consultants and some of the most experienced interventional radiologists in the UK.

Adjuvant treatment after Pancreatic Cancer surgery

The 5-year survival following resection of a pancreatic adenocarcinoma can be doubled by the addition of chemotherapy. Common drugs given after surgery include gemcitabine, 5FU, capecitabine or combinations of the above. Your oncologist will explain all the side effects and benefits of treatment. Generally however, chemotherapy for pancreatic cancer is tolerated extremely well.

Cyberknife treatment of Pancreatic Cancer

The team at London Bridge Hospital have access to the only cyberknife unit in the UK based at the Harley street Clinic (another HCA hospital). This offers very precise radiotherapy in much higher doses. Much has been made about this therapy in the press. The honest answer to these claims is that we, as yet, are unclear of the place of the cyberknife as a treatment for pancreatic cancer and its potential benefits (if any). However, it is available via the London Bridge team if this is something you would like to contemplate.

Other trial treatments for pancreatic cancer are available that cannot be removed. It is important to remember that, although a trial may sound attractive, as often new therapies are being tested, we have no idea they work. Hence the need for a trial to test them out. Also, most trials are randomized to a particular treatment or not and, therefore, you may not get the “new” treatment.

Palliation

If inoperable disease is found in the course of an operation that was commenced with the intent to remove the tumour, a choledocho-enterostomy (diversion of the bile flow into the gut) and a gastro-enterostomy (diversion of the flow of food, bypassing the duodenum) can be carried out, to relieve jaundice and duodenal obstruction.

In patients found to have unresectable disease on scans, jaundice is relieved by stenting at ERCP. Plastic stents tend to block faster, and if the patient is likely to have a longer life-expectancy, a self-expanding mesh metal stent can be used. If the patient is not a suitable candidate for endoscopic stenting, a percutaneous transhepatic stent can be placed. This involves puncturing the skin and placing a stent through the liver substance, and is done in the X-ray department.

Obstruction of the duodenum occurs in approximately 15% of cases; if this occurs early in the course of the disease, surgical bypass by gastrojejunostomy is appropriate, but if it is late in the course of the disease then the use of expanding metal stents inserted endoscopically should be considered.

Pain, a common problem with advanced pancreatic disease cannot only be managed by the palliative care team. The London Bridge has a number of anaesthetists expert in chronic pain relief. There are a number of nerve block therapies which can help with the pain of pancreatic cancer patients.

If no operative procedure is undertaken, biopsy of the tumour should be performed before consideration of chemotherapy or chemoradiation.

Possible complications of treatment for pancreatic cancer:

All surgery carries with it inherent risks which are different for each individual patient and influenced by the other medical conditions which the patient may suffer from. For example if a patient has heart or lung disease or is in kidney failure.

Smoking carries an increased risk and this risk can be dramatically reduced if the patient were to stop smoking for at least four weeks before surgery.

However, in patients who were previously fit and well the risk of major complications is low and the risk of death is extremely low (1% of patients). However, as with any major surgical procedure, complications can occur which may be directly related to the operation site - infection or leakage for example. Problems can normally be treated without recourse to further surgery.

If the spleen has been removed during surgery, patients will need specific vaccines and antibiotics on a daily basis, before leaving hospital. There are other complications such as chest infections, heart problems or thrombosis in the leg/veins or lungs. In addition, if the size of the remaining part of the pancreas is small, the patient may become diabetic requiring daily insulin injections.

Occasionally during surgery, it becomes obvious to the surgeon that the tumour is larger and more extensively involved than was shown on the CT scans. In this situation, the surgeon’s judgement is paramount and he may feel that it would not be safe or advisable to perform the planned operation and a slightly less complex procedure may be performed instead.

Further treatment for Pancratic Cancer:

Once the pancreas has been removed, it is sent off to our specialist Liver Histopathologist to be examined under microscope and this will determine further treatment. For example if the cancer has spread into the lymph glands or the small blood vessels which will have been removed alongside the pancreas, there will be an increased risk that the cancer will reappear in the future. The patient is then referred to our Medical Oncology team - experienced and caring physicians and nurses who specialise solely in cancer chemotherapy who will guide you to make the best choices for your own personal situation.

Naturally, the patient will continue to be reviewed as an Outpatient in our clinics and our team are always available for any worries or concerns that a patient may have.